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IOL Selection in patients with prior Corneal & Refractive Surgery

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IOL Selection in patients with prior Corneal & Refractive Surgery

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  1. IOL Selection in patients with prior Corneal & Refractive Surgery Dr Kareeshma Wadia DNB, FNN Cataract, Cornea and Refractive Surgeon Director- Jehan Eye Clinic, Mumbai

  2. Tools Required For Calculation Of Iol Power After Keratorefractive Surgery • TOPOGRAPHIC DATA • IOL MASTER/ LENSTAR (IF AVAILABLE) • ACCURATE OPTICAL/IMMERSION BIOMETRY • IF AVAILABLE -PRE LASIK DATA -POST LASIK DATA PRIOR TO DEVELOPMENT OF CATARACT • USING ONLINE POST KERATOREFACTIVE IOL POWER CALCULATOR (www.iolcalc.org)

  3. What to do when patient comes in my opd • I HAVE ACCESS TO TOPOGRAPHY • I HAVE ACCESS TO OPTICAL BIOMETER ,LENSTAR OR IOL MASTER • I DON’T HAVE ACCESS TO TOPOGRAPHY

  4. I have access to topography • Placido • Scheimflug • Scanning slit • Placido + scheimflug • OCT

  5. PLACIDO BASED EYE SYS 2000 CORNEAL ANALYSIS SYSTEM • HUMPHREY – ZEISS TOPOGRAPH OCULUS KERATOGRAPH

  6. Schiempflug

  7. Case based example 1 • 60/f • LASIK DONE MANY YEARS BACK • NOW HAVING IMMATURE CATARACT BOTH EYES • WANTING SPECTACLE INDEPENDENCE

  8. LEFT EYETORIC

  9. OUTCOMES

  10. 6 WEEKS POST OP

  11. CASE 2 • 52/M • RK DONE 26 YEARS BACK • PRE-OP REF WAS AROUND -3.5 BE • 2YEARS POST RK -7.5 • CURRENT REF -10.75DS/-0.75 DC 6/9 • LENS NS2 WITH POST CORTICAL OPACITIES

  12. REFRACTIVE EQUIVALENT POWER

  13. Uneventful Phacoemulsification

  14. http://www.doctor-hill.com/iolmain/topography.htm

  15. Take home message in post RK patients • Optical zone is much smaller • Be Prepared for hyperopic surprises • Target myopia • Limbal incisions> clear corneal • Proper patient counseling • Consent should include possibility of gaping of preexisting scars, refractive surprises, use of sutures.

  16. Summary • IOL power calculation in Compromised Corneas requires special attention • Counseling of patient with regards to refractive surprises should be done • Unrealistic expectations of the patients should be carefully addressed.

  17. Dr Kareeshma Wadiajehaneyeclinic@gmail.com

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